By
Shannon Savage
RECOMMENDED:
_____________________________________________
Marcia Howell, JD
_____________________________________________
Elizabeth Hodges Snyder, PhD, MPH
_____________________________________________
Rhonda Johnson, DrPH, MPH, FNP
Chair, Advisory Committee
_____________________________________________
Virginia Miller, DrPH, MS, MPH
Chair, Department of Health Sciences
APPROVED: _____________________________________________
Susan Kaplan PhD
Administrative Dean, College of Health
_______________________________________________
Date
ALASKA YOUNG DRIVER SAFETY:
DISTRACTED DRIVING, SEAT BELT USE AND DRINKING AND DRIVING
A
PRACTICUM PROJECT REPORT
Presented to the Faculty
of the University of Alaska Anchorage
in Partial Fulfillment of Requirements
for the Degree of
MASTER OF PUBLIC HEALTH
By
Shannon Savage
Anchorage, AK
ABSTRACT
United States teenagers have the highest crash rate of any group in the nation. The data tell us that there are eight identified leading causes of teen injuries and deaths associated with vehicle collisions: Driver inexperience; driving with teen passengers; nighttime driving; not using seat belts; distracted driving; drowsy driving; reckless driving; and impaired driving (CDC, 2014). Alaska data tell a similar story. The leading causes of crashes for Alaskan teen drivers are: driver inattention, unsafe speed, failure to yield and driver inexperience (Alaska Injury Prevention Center, 2012).
In partnership with the Alaska Injury Prevention Center, this practicum project created a resource guide identifying best practices in teen driving interventions connected to three of these areas: distracted driving, seat belt use and drinking and driving. The Strategies to Support Safe Teen Driving in Alaska resource guide is intended as a tool for community partners to access information about interventions for distracted driving, seat belt use and drinking and driving for Alaska teens and to work to put those interventions into action in their local communities.
Project research efforts included a synthesis review of available intervention reports, including a multi-step filtering process that distilled available program literature down to a final collection of strategies based on best available evidence. These resulting strategies were categorized into a taxonomy identifying currently available approaches, and were also classified into levels of promise associated with certainty of effectiveness and potential population impact.
Upon evaluation of intervention types within a Promise Table structure, the strategies found to be most promising were all public policy efforts surrounding graduated drivers’ licensing
programs, a minimum legal drinking age at 21, cell phone restrictions while driving and seat belt requirements. In addition, the community role of creating partnerships to prevent unsafe teen driving behaviors, as well as the parental role of boundary setting and monitoring their teen’s driving behavior, were found to have equal levels of promise. Of most significance was the finding identifying the importance of executing teen driving strategies with diverse influences, including all levels of the Social Ecological Model’s influence (i.e. public policy, community, organizational, interpersonal and intrapersonal).
Additional priority areas included attention to matters of community culture, public policy, enforcement and parental influence. Resulting recommendations include multiple public policy enhancements in the state of Alaska, including graduated driver’s license program modifications, enhancement of the state’s zero-tolerance policy and broad scale restrictions of driver cell-phone use.
TABLE OF CONTENTS
Page Signature Page ………...………... Title Page ………...…... Abstract ………...…………... 1 2 3 Table of Contents ………...……... 4 List of Figures ………...………... List of Tables ……….………...………... List of Appendices ………... 6 6 7 Chapter 1 Introduction ………...………... 8Challenges in public health practice ………... 8
Essential services of public health ………... 9
Alaska Injury Prevention Center (AIPC) ………... 10
AIPC efforts to support safe driving ………... 10
Scope of project ………...…………... 11
Chapter 2 Background and Significance ………... 12
Distracted driving ………...………... 12
Seat belt use …….………...………... 14
Drinking and driving ……….………... 16
Healthy Alaskans 2020 ………...……... 17
Chapter 3 Project Goal and Objectives ………...………..…... 19
Goal ………...…... 19 Objectives ………...………... 19 Chapter 4 Methods ………...………... 20 Methodological approach ………... 20 Conceptual framework ………... 21 Project design ………...………... 22
Data collection and analysis ………... 22
Page Chapter 5 Results ………...………... 29 Public policies ………...………... 30 Policy enforcement ………...………... 33 Community roles …………...……...………... 36 Parental roles ………...………... 40 Youth programs ………..………... 42 Technology solutions ………...……... 47
Promise Table findings ………..………...………... 50
Identified evaluation techniques ………...…... 52
Additional findings of significance ………... 52
Chapter 6 Discussion, Strengths and Limitations …………... 54
Implications of results ………...………... 54
Strengths ………...………... 56
Limitations ………...………... 56
Additional investigation needed ………...……... 60
Chapter 7 Conclusions and Recommendations ………...…... 62
Unique considerations for teen driving ………... 62
Priority areas ………... 63
Recommendations for practice in Alaska ………... 64
Future practice ………... 65
References ………...………... 67
LIST OF FIGURES
Page Figure 4.1: The Social Ecological Model ... 22 Figure A-1: Taxonomy of interventions for teen driver distraction, seat belt use and drunk driving ……….. 91
LIST OF TABLES
Page Table 4.1: Promise Table for categorizing potential interventions ... 26 Table B-1: Promise Table findings for teen driving interventions ……….. 92
LIST OF APPENDICES
Page Appendix A: Taxonomy of interventions ... 91 Appendix B: Intervention types and impact for teen driving ………... 92 Appendix C: Strategies to Support Safe Teen Driving in Alaska, resource guide ... 93
CHAPTER ONE: INTRODUCTION
The statistics are definitive; United States teenagers have the highest crash rate of any group in the nation. In 2013 (most recent available data), 963,000 drivers aged 16-19 were involved in police-reported crashes, resulting in 383,000 injuries and 2,865 deaths (AAA Foundation, 2015). In AIPC’s review of Alaska crash data from 2002 to 2012, 17 percent of crashes involve a teen driver, while the 2010 census reported Alaska teens only make up 7 percent of the State’s population (Alaska Injury Prevention Center, 2012)
Based on these numbers, it is no surprise that motor vehicle collisions are the leading cause of death for U.S. teens. Seven teenage drivers aged 16 to 19 die every day from motor vehicle injuries (CDC, 2014). While teen drivers make up 6 percent of all licensed drivers, they are involved in 14 percent of fatal crashes and 18 percent of all serious police-reported crashes (Cazzulino et al., 2014). For every mile driven, teen drivers are nearly three times more likely than drivers aged 20 and older to experience a fatal crash (CDC, 2014).
Challenges in public health practice
Many of these high crash rates for young drivers are partially attributed to immaturity and inexperience in operating a vehicle. This combination of factors can lead to engagement in high-risk driving behaviors, such as speeding, tailgating, driving under the influence of alcohol or drugs, underestimating hazardous driving situations, and driver distractions (Goldzweig et al., 2013). As new drivers, not having yet acquired the skills and knowledge that older drivers have come to attain over many years of driving, teenagers lack the experience to accurately assess and safely react to certain conditions (Adeola & Gibbons, 2013).
The data tell us that there are eight identified leading risk factors of teen crashes: (1) driver inexperience; (2) driving with teen passengers; (3) nighttime driving; (4) not using seat belts; (5) distracted driving; (6) drowsy driving; (7) reckless driving; and (8) impaired driving (CDC, 2014). For Alaska teen drivers, the leading causes of crashes are (1) driver inattention, (2) unsafe speed, (3) failure to yield and (4) driver inexperience (Alaska Injury Prevention Center, 2012).
It appears that gender plays a role in the likelihood of a significant incident while driving. Young people aged 15-24 represent only 14 percent of the U.S. population. However, they account for 30 percent ($19 billion) of the total costs of motor vehicle injuries among males and 28 percent ($7 billion) of the total costs of motor vehicle injuries among females (CDC, 2014). Interestingly, teens’ perception of their safety risks appear to be out of sync with the risk and cost data, as 32 percent of male teen survey respondents reported that they were extremely safe drivers, whereas
only 18 percent of females participating in the survey reported that they were extremely safe drivers (Barr et al., 2015).
Essential services of public health
According to the Centers for Diseases Control and Prevention (CDC) website, the 10 Essential Public Health Services describe the public health activities that public health professionals provide and communities engage with, to serve as the framework for public health practice. Public health systems should:
1. monitor health status to identify and solve community health problems;
2. diagnose and investigate health problems and health hazards in the community; 3. inform, educate, and empower people about health issues;
4. mobilize community partnerships and action to identify and solve health problems; 5. develop policies and plans that support individual and community health efforts; 6. enforce laws and regulations that protect health and ensure safety;
7. link people to needed personal health services and assure the provision of health care when otherwise unavailable;
8. assure competent public and personal health care workforce;
9. evaluate effectiveness, accessibility, and quality of personal and population-based health services; and
10.research for new insights and innovative solutions to health problems.
Of these ten essential services, a significant number of them put public health practitioners in a position to be able to act on staggering teen driving statistics. In efforts to curb the injuries and mortality associated with teens driving, practitioners are able to assist by:
monitoring the ongoing status of harmful teen driving incidences;
investigating the underlying factors that contribute to the current issues associated
with teen driving;
informing, educating and empowering teens, their family members, and
communities about potential solutions to combat the current problems;
mobilizing community partnerships in order to enact solutions to support safer
driving environments for all community members;
working on the development and implementation of policies and plans to support
advocating for strict enforcement of laws and regulations that contribute to safe
driving, such as seat belt requirements or prohibition of texting while driving;
educating on the significant issues related to unsafe teen driving;
working to identify best practices in safe driving programs for teens, in order to
ensure high quality intervention strategies are available wherever possible; and
continuing to seek out new ways of engaging with young people, in order to foster
safe driving behaviors.
Alaska Injury Prevention Center as a public health community partner
The Alaska Injury Prevention Center (AIPC) is a nonprofit organization governed by a board of directors. AIPC has a mission to prevent injuries across Alaska, and has taken on the challenge of working to increase safe teen driving conditions throughout the state (Alaska Injury Prevention Center, 2015).
AIPC was first established in 1996. Originally known as the Anchorage Safe Communities Coalition, this group of injury prevention professionals, health care providers, and concerned citizens joined together to implement community interventions to reduce the number of deaths and injuries from preventable causes in their Anchorage community. Coalition members were
responsible for Anchorage becoming the second internationally designated safe community in the world, through work with the World Health Organization (WHO) (Institute for Circumpolar Health Studies, 2001).
Since their original inception, the Anchorage Safe Communities Coalition has evolved, including a name change in 2000 to the Alaska Injury Prevention Center. The Coalition has changed and expanded its focus over time to meet the needs of the community and the interests of its members. This has been a successful enterprise that has maintained both interest and momentum for the past nearly twenty years (Institute for Circumpolar Health Studies, 2001)
Today, the Alaska Injury Prevention Center continues to monitor trends in injury data to prioritize prevention efforts. Current projects include Motor Vehicle, Bicycle and Pedestrian Safety; Suicide Prevention; Elder Safety and Kid Safety; with a strong emphasis on Evaluation (Alaska Injury Prevention Center, 2015).
AIPC efforts to support safe driving
AIPC believes in approaching public health interventions with thorough consideration of available data, including analyzing the epidemiology of a type of injury or cause of death, and
considering potential interventions relevant to both the mechanical causes as well as the human elements. The Center seeks to implement interventions that address the specific elements of causation and to design interventions relevant and appropriate to their targeted populations (Institute for Circumpolar Health Studies, 2001).
In collaboration with a number of community partners, AIPC was awarded a grant for their Safe Streets initiative on October 1, 2014. As the project lead, the organization has worked with partners throughout Alaska to fulfill components of the project over the months since its award, and continues to work toward the finalization of additional items before the project’s completion on September 30, 2015.
In partnership with AIPC, the practicum project, described herein, contributed to the Safe Streets project, by developing a resource guide. The Strategies to Support Safe Teen Driving in Alaska resource guide is intended to be a tool for community partners to access information about available interventions for distracted driving, seat belt use and drinking and driving for Alaska teens. In keeping with the center’s approach, all recommendations in the guide were evaluated for alignment with best practice.
Upon completion in September 2015, the guide will be made available on AIPC’s website, as well as through all of their social media outlets. It will be made available to a variety of local, as well as statewide partners, including schools. It will also be publicized with the South East Alaska Regional Health Consortium (SEARHC), as well as with the Alaska Native Tribal Health Consortium (ANTHC), for distribution to other regional hubs for injury prevention across the state.
Scope of project
The Strategies resource guide is intended to be most relevant to high school students in Alaska who are or will be driving licensed vehicles on the state’s road systems.
The guide is also specifically targeted toward three major factors that contribute to teen driving safety: reducing distracted driving, increasing seat belt use and decreasing drunk driving. As these three areas of emphasis were identified as priorities by the Safe Streets project team, the guide will primarily evaluate interventions specifically related to these topics, in order to maintain an evaluation closely aligned with the outcomes of interest.
CHAPTER TWO: BACKGROUND AND SIGNIFICANCE
The research in development of a resource guide for Alaska teen driving interventions will focus on three subject areas: distracted driving, seat belt use, and drinking and driving.
Distracted driving
Distracted driving is an increasing problem in the United States. Distracted driving is defined as any activity that could divert a person's attention away from the primary task of driving,
endangering drivers, as well as passenger and bystander safety. These types of distractions include: texting; using a cell phone or smart phone; eating and drinking; talking to passengers; grooming; reading, including maps; using a navigation system; watching a video; or adjusting a radio, CD player, or MP3 player (U.S. Department of Transportation, 2014). A distracted driver may experience slow reaction time, degraded awareness of exterior objects, roadway signs or traffic signals, and reduced vehicle control, such as drifting into other lanes or into the shoulder of the road (Adeola & Gibbons, 2013).
Young drivers are the age group most likely to be involved in a crash or near-crash because of distracted driving (Adeola & Gibbons, 2013). Teens make up the largest group of distracted drivers, and 11 percent of teen drivers in fatal auto accidents were reported as distracted at the time of the crash (Bratsis, 2013). In a recently completed study by AAA that analyzed video footage of more than 1,700 accidents, video analysis found that distraction was a factor in nearly 6 out of 10 moderate-to-severe teen crashes, which is four times as many as official estimates based on police reports (AAA Foundation, 2015). Results showed that distraction was a factor in 58 percent of all crashes studied; including 89 percent of road-departure crashes and 76 percent of rear-end crashes. The National Highway Traffic Safety Administration (NHTSA) previously had estimated that distraction is a factor in only 14 percent of all teen driver crashes (AAA Foundation, 2015).
The illusion of invincibility is a normal phase of social and cognitive adolescent development that can lead teens and young adults to mistakenly believe that they are immune to the
consequences of high-risk behaviors. When empowered with no fear of consequence, teens and young adults are more likely to engage in high-risk behaviors. Feelings of invincibility allow young drivers to falsely assume that they are immune from injuries and consequences associated with the high-risk behavior of distracted driving (Adeola & Gibbons, 2013). Furthermore, in recent years, automakers have standardized the incorporation of electronic devices into motor vehicle design, with Bluetooth® wireless technology, dashboard Internet connection, and GPS navigation systems. The integration of such wireless technologies into everyday driving and non-driving life can lead
drivers to assume that mobile technologies can be used safely behind the wheel. However, using these devices while driving can have devastating consequences (Adeola & Gibbons, 2013).
There are three main types of distraction—visual, manual, and cognitive. A visual distraction is any distraction that takes the driver's eyes off the road; manual distractions are distractions that take the driver's hands off the steering wheel; and a cognitive distraction is any distraction that takes the driver's mind off the task of driving (Adeola & Gibbons, 2013). Because text messaging requires visual, manual, and cognitive attention from the driver, it is by far the most alarming distraction (Distraction.Gov, 2014). At any given daylight moment across America, approximately 660,000 drivers are using cell phones or manipulating electronic devices while driving, a number that has held steady since 2010 (Distraction.Gov, 2014).
Nearly half of U.S. teens say they have been in a car when the driver was texting (Bratsis, 2013). Although almost all drivers believe that texting while driving is unsafe, 52 percent of drivers aged 18 years or less reported texting while driving on a daily basis. Seventy percent of young drivers reported initiating texts while driving; 81 percent reported replying to texts while driving, and 92 percent reported reading texts while driving (Adeola & Gibbons, 2013). A quarter of teens respond to a text message once or more every time they drive. (Distraction.Gov, 2014).
Upperclassmen, the students most likely to drive, are the worst violators: 58 percent of seniors and 42.9 percent of juniors said they had texted at least once while driving in the past 30 days (Bratsis, 2013).
A concerning 20 percent of teens and 10 percent of parents also admit that they have extended, multi-message text conversations while driving (Distraction.Gov, 2014). Statistics tell us that young men are more likely than their female counterparts to use their phone while driving, as well as text (Barr et al., 2015). In Alaska, 34.2 percent of high school students who drove a car or other vehicle during the past 30 days, texted or emailed while driving on one or more of the past 30 days. This is lower than the National average of 41.4 percent (State of Alaska, 2014).
The concentration needed for safe driving makes texting safely at the same time impossible, research shows (Bratsis, 2013). A driver’s reaction time doubles when sending or reading a text. Sending or reading a text takes a driver’s eyes off the road for an average of 4.6 seconds. At 55 mph, that’s like driving the length of a football field blindfolded (Bratsis, 2013). Crash risk estimates based on observation studies of driver behavior suggest that driving while texting is at least five to six times as bad as drunk driving (Atchley, Hadlock & Lane, 2012).
Alaska state law currently prohibits all drivers from texting while driving. Drivers who are identified as operating a vehicle while texting are subject to the following punishments:
Texting and driving (only) is a Class A Misdemeanor with up to a $10,000 fine and
one year in prison.
Texting and driving that results in an injury is a Class C Felony with up to a $50,000
fine and five years in prison.
Texting and driving that results in a serious injury is a Class B Felony with up to a
$100,000 fine and ten years in prison.
Texting and driving that results in a fatality is a Class A Felony with up to a $250,000 fine
and twenty years in prison (State of Alaska Department of Public Safety, 2015) Seat belt use
Evidence-based recommendations from the US Task Force on Community Preventive Services state, “Safety belts are the single most effective means for vehicle occupants to reduce the risk of death and serious injury” (Reisner et al., 2013). Each year, safety belts prevent an estimated 15,700 fatalities, 350,000 serious injuries, and $67 billion in costs associated with traffic injuries and deaths (Melnick et al., 2010).
Although seat belts are one of the most important safety inventions in automotive history, there are still teens that do not use them. Results of a survey indicated that in Alaska, 10.1 percent of high school students reported that they rarely or never wore a seat belt when riding in a car driven by someone else (compared with 7.6 percent as the national average) (State of Alaska, 2014). Observations of Anchorage teens driving to school show a seatbelt use rate of 90.3% (Alaska Injury Prevention Center, 2015). Correspondingly, adult seatbelt use in Alaska in 2015 is 89.3%. (Alaska Injury Prevention Center, 2015)
Black and Hispanic drivers were still less likely to use seat belts while driving compared to white drivers. Female drivers and drivers who had passengers in their vehicle had increased odds of seat belt use (Goldzweig et al., 2013). Findings identified a 6 percent increase in the risk of seat belt omission for each additional year of the respondent’s age, finding that the seat belt use rate for 18- to 19-year-old drivers was 33 percent lower than for 16- to 17-year-old drivers. Zuckerman (1983) observed that seat belt omission peaks around age 19 or 20 (Melnick et al., 2010).
While important that people of any age wear seat belts, it is especially important for teenagers, because their crash rate is much higher than other age groups in the United States (Goldzweig et al., 2013). In combination with this high crash rate, when compared with other age groups, teens also have the lowest rate of seat belt use. Despite substantial efforts aimed at increasing belt use among teens, observed seat belt use among teens and young adults (16–24 years old) was 81 percent in
2009 and dropped to 79 percent in 2010, representing the lowest for any age group (Goldzweig et al., 2013). Statistics show that nonuse of safety belts is even more common for adolescent
passengers than drivers (Reisner et al., 2013). In 2013, only 55 percent of high school students reported they always wear seat belts when riding with someone else (CDC, 2014). Female drivers were more likely than male drivers to self-report that they always make their passengers wear a seat belt (76 percent vs. 63 percent) (Barr et al., 2015).
Low seat belt use combined with higher crash rates contribute to persistence of motor vehicle crashes as the leading cause of teenage death (Goldzweig et al., 2013). Nationally in 2009, 3,349 teen passenger vehicle occupants, aged 16–20, were killed in motor vehicle crashes, and 56 percent were unrestrained at the time of the fatal crash. In 2012, 71 percent of drivers aged 15 to 20 killed in motor vehicle crashes after drinking and driving were not wearing a seat belt, and more than half of all teen drivers killed in 2012 were not wearing a seat belt (CDC, 2014).
The protective effect of using a three-point seat belt (shoulder and lap) either as a driver or passenger reduces the risk of being killed or severely injured in a motor vehicle crash by almost 50 percent (Melnick et al., 2010; Goldzweig et al., 2013). Seat belts prevent ejection from the vehicle, spread forces from the crash over a wide area of the body, allow the body to slow down gradually, and protect the head and spinal cord from serious injury (Goldzweig et al., 2013). Not only are interventions to increase seat belt use by young people greatly needed, but also targeted strategies that take into consideration age, gender, race, urban/rural, and regional differences in seat belt use (Goldzweig et al., 2013).
Significantly more females (91 percent) compared to males (77 percent) reported always wearing their seat belts (Barr et al., 2015). Variations in teen seat belt use have not only been observed by gender, but by race/ethnicity. In recent data released by the CDC, the prevalence of rarely or never wearing a seat belt was higher among African American students (10.3 percent) and Hispanic students (9.3 percent) than White students (6.3 percent) (Goldzweig et al., 2013). These differences correspond with gender and racial/ethnic disparities in death, disability, and injury from motor vehicle crashes, with adolescent boys age 16 and racial/ethnic minorities bearing the highest burden (Reisner et al., 2013). Interestingly, correlations were also found with a teen’s participation in organized sports. Risk-taking by not wearing a seat belt was found to be lower among athletes (as compared to non-athletes), including both moderately involved athletes (one or two team memberships in the past year) and highly involved athletes (three or more team
memberships) (Melnick et al., 2010). Additional individual risk factors for safety belt nonuse in youths include overweight and obesity, alcohol (drinking as well as being a passenger with a drunk
driver), depression, and lower levels of academic achievement (Reisner et al., 2013).
Strong evidence indicates that seat belt laws are among the most important interventions in increasing safety belt use. Seat belt laws have been enacted by states since 1984 and vary in the nature of their provisions, with some allowing enforcement officers to make a traffic stop based only on the non-use of a seat belt (known as primary enforcement laws), while others only allow officers to note the violation of non-seat belt use if they have already pulled the driver over for a different infraction (such as failing to use a signal). These jurisdictions have what is known as secondary enforcement laws. Previous research has shown that primary safety belt laws are associated with higher safety belt use and lower crash-related injuries and mortality in the general population as compared with secondary laws (Adkins, 2014). Because some teenage populations have lower safety belt use, even with primary enforcement laws, combined approaches that include upgrades to laws with campaigns and increased enforcement might be warranted. In addition, evidence indicates that primary enforcement safety belt laws may play a key role in mitigating the disparity in safety belt use among certain teen groups. As of March 2012, only 17 US states still have secondary safety belt laws in effect, and New Hampshire still has no safety belt law at all (García-España, Winston & Durban, 2012).
In Alaska, as of May 2006, state law requires seat belts for all drivers and identifies this as a primary law, meaning that law enforcement officers can pull drivers over based solely on suspicion of non-compliant seat belt use (Insurance Institute for Highway Safety, 2015). According to the State of Alaska’s Department of Public Safety website (2015), “A driver may be fined up to $50 statewide and $200 in the Municipality of Anchorage and may receive two points on their
operator’s license for failure to restrain passengers under age 16. Adult violations are subject to a $15 fine statewide and a $60 fine in the Municipality of Anchorage.”
Drinking and driving
Impaired driving is a significant problem among teenagers in the United States. Despite concerted efforts to decrease the number of associated deaths and injuries, the statistics continue to rise nationwide. Drinking and driving greatly increases the risk for motor vehicle accidents among teenagers and is a relatively common occurrence despite that all states now have 21-year-old minimum drinking age laws (CDC, 2014). Data found that Christmas vacation, spring vacation, and prom nights/ weekends were the periods during which incidence of teenage alcohol-related crashes increased (Powers-Jarvis, 2014).
At all levels of blood alcohol concentration (BAC), the risk of involvement in a motor vehicle crash is greater for teens than for older drivers (CDC, 2014). In 2008, nearly 25 percent of teenage drivers who died in motor vehicle accidents had a blood alcohol concentration (BAC) of 0.08 g/dl or higher (considered to be alcohol impaired) and 31 percent had detectable BAC (Cavazos-Rehg et al., 2012). In 2012, 71 percent of drivers aged 15 to 20 who were killed in motor vehicle crashes after drinking and driving were not wearing a seat belt (CDC, 2014).
Nationally, a total of 11.7 percent of students reported having ‘driven after drinking any alcohol’ and 28.2 percent reported riding in a car with a driver who had been ‘drinking on one or more occasions in the past 30 days.’ (State of Alaska, 2014) Alcohol use, particularly binge drinking (which is common among adolescents), has been associated with neurocognitive deficits and increased risk-taking behaviors, which may contribute to negative driving outcomes among adolescents even while sober. In previous large-scale surveys, researchers found that binge-drinking adolescents are more likely to drive after binge-drinking (Marcotte et al., 2012).
In Alaska, 13.1 percent of high school students reported having ridden one or more times during the past 30 days in a car or other vehicle driven by someone who had been drinking alcohol (versus the national average of 21.9 percent) and 3.4 percent of students who drove a car or other vehicle during the past 30 days, drove when they had been drinking alcohol one or more times during the past 30 days (compared to national average of 10.0 percent) (State of Alaska, 2014).
The percentage of teens in high school that drink and drive has decreased by more than half since 1991, but more can be done. Nearly one million high school teens drank alcohol and got behind the wheel in 2011 (CDC, 2014). Teen drivers are 3 times more likely than more experienced drivers to be in a fatal crash. Drinking any alcohol greatly increases this risk for teens (CDC, 2014). Research has shown that factors that help to keep teens safe include parental involvement,
minimum legal drinking age and zero tolerance laws, and graduated driver licensing systems. These proven steps can protect the lives of more young drivers and everyone who shares the road with them (CDC, 2014).
Healthy Alaskans 2020
Healthy Alaskans 2020 (also known as HA2020) brings together partners from many sectors across the state to improve health and ensure health equity for all Alaskans through shared understanding, united efforts, and collective accountability (State of Alaska, 2012).
Based on the latest scientific evidence around improving health, along with community input from more than 3,000 Alaskans, the HA2020 framework identifies 25 health priorities that are regularly monitored and available publicly.
Of the identified 25 health priorities that make up HA2020, the following two priority metrics have the potential to see a direct impact by the reduction of drinking and driving in teens, an increase in seat belt use and a decrease in distracted driving among Alaska high school students:
Priority: Reduce the number of Alaskans experiencing alcohol and other drug
dependence and abuse
o Indicator: Alcohol induced mortality rate per 100,000 population Baseline in 2010: 16.3 per 100,000
Goal by the year 2020: 15.3 per 100,000
o Indicator: percentage of adolescents who report binge drinking in the past 30 days
based on the following criteria: 5 or more alcoholic drinks in a row within a couple of hours, at least once in the past 30 days
Baseline in 2010: 21.7 percent Goal by the year 2020: 17 percent
Priority: Reduce Alaskan deaths from unintentional injury
o Indicator: Unintentional injury mortality rate per 100,000 population Baseline in 2010: 58.3 per 100,000 HA2020
CHAPTER THREE: PROJECT GOAL AND OBJECTIVES
This practicum project specifically sought to better understand the public health area of safer teen driving, with specific emphasis on safe driving interventions aimed at reducing distracted driving, increasing seat belt use and decreasing the rate of drinking and driving among Alaska high school students.
At present, while there is some research being conducted regarding this topic at a national level, little to none is available with specific regard to Alaska high school students.
Using a combination of Strategic Highway Safety Plan driver behavior aims, and additional consultation with practicum site Alaska Injury Prevention Center (AIPC), the following goal, and ensuing objectives were developed.
Goal:
Improve quality and accountability for youth safe driving programs in the state of Alaska, with an emphasis on implementation of interventions and measurements that adhere to established best practices and are appropriate to Alaska youth.
Objectives:
Identify a minimum of ten interventions that target youth driving behaviors of distracted
driving, seat belt use, or drinking and driving, that are aligned with current promising practices and relevant to Alaska high school students. To be completed no later than September 30, 2015.
Create a resource guide for the state of Alaska that outlines interventions and potential
success indicators related to best practices in targeting youth driving behaviors of distracted driving, seat belt use, and drinking and driving, relevant to Alaska high school students. To be completed no later than September 30, 2015.
CHAPTER FOUR: METHODS
The goal of this project was to improve quality and accountability for youth safe driving programs in the state of Alaska, with an emphasis on implementation of interventions and
measurements that adhere to established promising practices and are appropriate to Alaska youth. This section describes the methods utilized to reach answers to the original research questions and aims of this project (listed below).
Research questions:
What interventions are currently available to prevent distracted driving, encourage seat
belt use and prevent drinking and driving among high school students in Alaska?
Of the available interventions, which are based on promising practice? Of these, which are
most appropriate to the unique needs of Alaska high school students?
What standardized measures should be used to evaluate the collective impact of
interventions selected to prevent distracted driving, encourage seat belt use and prevent drinking and driving, among Alaska high school students?
Project aims:
Upon identification of finalist interventions, compile a summary of each to be developed
into a resource guide for promising practices, related to behaviors of distracted driving, seat belt use and drinking and driving, especially for young Alaska drivers.
Determine any standardized measures used to better evaluate collective impact of youth
safe driving and underage drinking prevention interventions, to be included in resource guide.
Methodological approach
In seeking to develop a final list of interventions for safe teen driving that are considered best practice, there was a challenge in determining the criteria to establish best practice. Swinburn, Gill and Kumanyika (2004) point out that ‘evidence-based’ public health practice is often inhibited by the mismatch between a significant spread and importance of a problem, compared to very little available evidence on the specific efficacy of potential interventions to address it.
They go on to distinguish the importance of becoming comfortable with using ‘best available’ evidence, versus ‘best possible’ and also make a strong case for the importance of expanding the body of admissible evidence to include considerations of contextual and policy relevance,
implementation capabilities and sustainability.
With the medical world setting a standard for best practice that relies upon such rigor as is associated with randomized control trials (RCT), and direct results after a defined intervention, there is a pervasive perception among researchers that an intervention cannot be viably classified as a promising or best practice, unless subjected to the same stringent evaluations (McNeil & Flynn, 2006).
The challenge is that in public health practice, many intervention approaches may have limited or diffused visibility at their outset, with impacts that are very gradual (e.g. population perceptions and behaviors that adjust slowly over time), and as a result, without the medically standardized phenomenon of visible uptake and effect, these interventions are not considered assessable by normalized standards of quality determination (Swinburn, Gill & Kumanyika, 2004).).
In setting an approach for this project, there was an opportunity to adopt an evaluation system that took into account the unique and meaningful variables in public health practice
implementation that are often overlooked as valid indications of promising practice. One particularly important component to guide the evaluation process was the use of a strong conceptual framework, based in known public health recommended practices (McNeil & Flynn, 2006).
Conceptual framework
In 1988, Bruce Simons-Morton, in collaboration with colleagues Parcel and Bunker, developed an adaptation of Bronfenbrenner’s original levels of Ecology of Human Development. This updated model, which became known as the Social Ecological model, quickly became a standard framework by which to evaluate the various social levels impacted by any one intervention (Simons-Morton, McLeroy & Wendel, 2012).
The Social Ecological Model (SEM) presents a natural choice as a conceptual framework for projects seeking to synthesize a wide variety of intervention strategies, all aimed at a specific population. The model (pictured in figure 4.1) contains five levels of impact at which an
intervention can occur: Intrapersonal, Interpersonal, Organizational, Community and Public Policy. Each of these levels is associated with particular health behaviors. For some interventions, there may be more than one level targeted by the proposed strategy. By using the Social Ecological model as a framework, one is able to easily see how one intervention is impacted by another— even if a single intervention is operating at a different levels (also referred to as a ‘nested’ intervention). Additionally, use of SEM enables quick evaluation of patterns of success associated with the
targeting of specific levels (Simons-Morton, McLeroy & Wendel, 2012).
Project design
The approach for this project’s data collection and review was based upon the approach used by McNeil and Flynn in their 2006 research on obesity prevention interventions.
Based on the flow process adapted by McNeil and Flynn from previous models (Swinburn, Gill & Kumanyika, 2004; Flynn et al., 2005), the design worked toward the creation of a portfolio of interventions aligned with promising practices in the field. This portfolio resulted after a multi-step filtering process that distilled available program literature down to a final collection of strategies based on best available evidence, while not excluding untried but promising interventions (McNeil & Flynn, 2006).
This project followed a six-step approach to refine a very large body of available interventions into a final portfolio of those considered leaders in promising practices.
Data collection and analysis
In its first phase, the project centered around a comprehensive search of all available resources (e.g. online databases, Internet sites, reference lists) for records regarding interventions that apply to safe teen driving. Identified records outlining a teen driving intervention that addressed seat belt use, distracted driving, or drinking and driving in some capacity were subject to additional
evaluation.
The steps below outline the adapted process used to take the large number of initial records, and systematically reduce those numbers down, based on a series of inclusion and exclusion criteria.
Once the quantity of records was reduced to a manageable number, remaining candidates were placed into a table outlining their relevant features, at which point they were classified into a taxonomy to enable a generalization of their particular approaches and interventional strategies for easy comparability. These taxonomic results were then each classified by degree of promising practice, and additional indicators of program success were noted.
Evaluation steps are outlined in greater detail below:
Step 0: Pre-evaluation criteria, including search parameters
Academic databases for this search were identified through use of the University of Alaska Anchorage’s Consortium Library. The library’s online portal has the ability to access and search through more than 250 databases of academic materials, with a number of powerful search engines that have the ability to review the content of multiple databases simultaneously. Of the available search resources on the library’s database, eight search engines were selected based on a high level of fidelity with the subject matter, and were used to access materials in more than 120 databases.
In addition to the consortium library’s search engines, an Internet search engine was selected to review World Wide Web content, with particular interest in seeking out gray literature records (such as government and community coalition program reports, press releases, promotional materials, etc.) that may not be contained in the academic databases previously searched, but held relevance to the proposed search.
Through analysis of initial search result materials and consultation with a reference librarian, the following search terms were identified as both inclusive and exclusive at appropriate levels to produce initial search results from which to filter records of relevance in following project review stages. While certain search engines possess technology to identify records with ‘related’
vocabulary/ synonyms for the search terms listed, the search terms in (parentheses) were added as alternative results to use for search engines that did not possess this capability.
Search terms used:
Safe*
AND Intervention
AND Driver
AND Teen (adolescent; high school; high school)
AND [seat belt (seatbelt; safety belt)] OR [drunk (drinking; alcohol)] OR [distract* (texting;
text message; text-message)]
Step 1: Broad inclusion criteria
Results from each academic search result were reviewed in whole, with records of potential significance (based on a review of title and abstract) set aside for more thorough review in following steps.
Approximately 14,000 records were reviewed in this phase. Significant duplication of results (across databases) was controlled for with use of an online record storage tool, accessible from all engines used. Internet search results were reviewed only to the point of identifying saturation of resulting record types and themes. This occurred within the first 400 Internet records reviewed (when sorted by ‘most relevant’ results first).
To continue past step one of record filtration, each report met the following criteria:
Identified by the search engine filter as published in English
Identified by the search engine filter as published in past 10 years (2005-2015)
Identified by the search engine as peer reviewed (academic databases only- Internet search
did not include this criterion)
Appeared pertinent to an intervention that targeted one or more of the desired outcomes
(drunk driving/ seat belt use/distracted driving)
Step 2: Critical appraisal
After being controlled for duplication of results, approximately 700 unique records were thoroughly reviewed to determine their appropriateness to this project.
Remaining reports needed to address at a minimum each of the following, in order to be considered viable for the remainder of the review process:
Had at least one identified outcome or process indicator
Identified program development and potential for program evaluation
Relevancy to population health principles as outlined in the social ecological model Potential relevancy to target population of high school students
Records that were pertinent from a contextual or background perspective, but that did not meet the above criteria were cultivated for use in background, discussion and strengths/limitations portions of this report, but were not included in the remaining filtration steps.
Step 3: Synthesis of findings
Of the initial records identified as potentially significant, a total of 162 met the criteria to continue on to step three. These remaining records were diagramed to outline pertinent
intervention characteristics for comparison.
Important data points identified and evaluated for each report were:
Program name(s) and geographic location
Program type, setting (e.g. school, home, etc.) and populations addressed Key program intervention features and identified outcomes
Timing of most recent information regarding this intervention
Resources needed for implementation
Gaps (in populations studied or in program foci)
Summary of best practices in program development and program effectiveness (only if
specific data available)
Upon completion of synthesis and evaluation of the gathered body of records, certain trends emerged, making it possible to categorize records into one of three types, based on patterns of content.
Materials were sorted into one of three types of record:
Single intervention evaluation, with limited best practice implication identified; Multiple interventions or programs evaluated, with some best practice implications
identified;
Large syntheses of programming, with significant implications for best practice identified.
Of the 162 records, 14 were considered large syntheses, 39 were considered midsize (multiple intervention) evaluations, and 113 were limited in their scope of review to focus on only one intervention.
Step 4: Creation of taxonomic structure to classify intervention types
Utilizing comparison of information from the large-scale syntheses, more explicit findings were identified. By evaluating for consistencies in synthesis results, a core set of intervention types used to address teen driving behaviors of distracted driving, seat belt use and drinking and driving
became clear. These main intervention types were classified into a taxonomy, which was then tested against the mid-size and limited-scope records to ensure appropriateness of fit with all identified intervention records.
Step 5: Population of Promise Table
McNeil and Flynn (2006) used a sorting tool known as a “Promise Table” (see Table 4.1) in order to categorize interventions into various states of likely success (i.e. levels of promise).
Using this approach, intervention types as defined by the taxonomic structure were assessed independently on both certainty of effectiveness, and potential for population impact, using available information contained in all three record types (large, mid-range and limited).
Certainty of effectiveness determinants:
Potential ranking for each intervention is:
quite high; medium; quite low
Ranking should be determined by the intervention’s level of internal validity and final
program outcomes
Potential for population impact determinants: Potential ranking for each intervention is:
high; moderate; low
Ranking should be determined by the intervention’s program logic, reach and uptake
Based on the two rankings of certainty of effectiveness, and potential for population impact, each intervention was categorized into one of five categories of “promise” potential (see Table 4.1). Potential levels of promise include:
o Most Promising
o Very promising
o Promising
o Less Promising
o Least Promising
Step 6: Evaluation of findings
Upon classification into various levels of promising practice, intervention types were evaluated for other trends and synergistic values, as identified by program literature. To provide additional structure, interventions were also evaluated according to alignment with the Social Ecological Model (SEM). This evaluation allowed for a single intervention type to be regarded as related to more than one level of the SEM.
In the process of reviewing records, additional significant results outside of the taxonomy were noted, such as individual program/intervention qualities of significance, synergistic qualities of more than one taxonomic feature applied within a single intervention effort, and general program design implications.
Upon completion and passage through filtration, classification and evaluation, all resulting intervention types were compiled into a portfolio discussing promising practices to increase safe driving for Alaska high school students.
These details are to be distributed in a resource guide, titled Strategies to support safe teen driving in Alaska, circulated through the Alaska Injury Prevention Center to various Alaska
stakeholder organizations who have a vested interest in program execution to address these issues.
This research presented minimal implications in the area of protection of research subjects. All data reviewed existed in publicly available databases, and while a small set of key informants was involved in project planning, they were not considered human subjects for this project, and their comments were not explicitly analyzed or reported.
An application to the University of Alaska Anchorage Institutional Review Board (IRB) was submitted April 23, 2015, seeking exempt review. It was approved and finalized May 11, 2015.
CHAPTER FIVE: RESULTS
After filtration and review of the large body of records regarding interventional approaches for the teen driving behaviors of distracted driving, seat belt use, and drunk driving, a general
taxonomy of intervention types resulted.
This taxonomic structure (located in Appendix A) identifies main types of interventions in use presently to address and positively impact outcomes for the targeted behaviors. There are six main categories of intervention types, with additional sub classifications:
Public Policies
o Minimum legal drinking age (MLDA) at 21 o Cell phone use laws
o Seat belt laws
o Graduated driver’s license (GDL) restrictions
Policy Enforcement
o Strength of enforcement
o Enforcement culture and knowledge base o Resource allocation
Community Roles
o Cultural engagement
o Community norms and awareness
o Restriction of alcohol access and availability o Partnerships
Parental Roles
o Instruction and role-modeling o Communication and engagement o Knowledge of policies
o Boundary setting and monitoring
Youth Programs
o School campaigns o Community connections o Formal driving instruction
Technology Solutions
o Vehicle-equipped technology o After-market technology o Phone-based applications
o Relevant communication channels
A review of findings affiliated with each of the six types follows. 1. Public Policies
While public policy regarding teen driving behaviors can often take a high degree of effort to implement or modify, research has shown that it makes a significant impact (Goodwin et al, 2013). While the effectiveness of certain policies on reducing negative teen driving outcomes are impacted by issues of enforcement and awareness, there are consistent results to indicate that the mere existence of a policy is a significant step in creating positive community norms. This leads to
approval of road rules and enforcement and perceived advantage to complying with them, which are critical elements impacting behavior change programming.
From the perspective of the Social Ecological Model, public policy (while an SEM level all its own) is considered a highly ‘nested’ strategy, impacting outcomes at all other levels (community, organizational, interpersonal and intrapersonal).
Examples include a policy’s ability to influence community normative behaviors, leading to peer pressure at an interpersonal level, and affecting beliefs at an intrapersonal level. Research has proven that policies are significantly enhanced in their effectiveness when paired with other initiatives such as policy publicity, enhanced enforcement, and campaigns to support social
perceptions of the policy-supported behavior as ‘normal’ for community members (Wilson, 2013). Interventions that encourage behavior not supported by an existing policy (e.g. encouragement not to text and drive, when there is no law against it) are found to be significantly less effective than the same intervention deployed in a location that has policy support in place (Adkins, 2014).
Minimum legal drinking age (MLDA) at 21
The establishment of a minimum legal drinking age (MLDA) has long been a legislative tool used to approach and reduce a number of risky youth behaviors connected with alcohol
consumption (Wilson, 2013). There has been more research on effectiveness of this approach than any other intervention directed at underage alcohol consequences, and it has been proven
consistently most successful in decreasing risks when established at 21 (Goodwin, 2013). There have been a number of significant lobbying efforts to reduce the MLDA to ages ranging from 18 to 20; thus far none have been successful. Many experts cite that maintaining minimum drinking age at 21, not lowering it, should be considered a significant priority in the work of preventing
underage drinking and driving (Goodwin, 2013).
An additional implication of minimum legal drinking age laws is the impact on legislation around “zero tolerance” policies. Zero tolerance refers to legislation that regulates what level of blood alcohol (BAC) is considered legal while operating a vehicle. While adult drivers have a BAC limit between 0.10 and 0.08 in most states, the presence of a zero tolerance policy maintains that a reduced level of blood alcohol in a young driver (under MLDA) is considered a violation of law, and subject to all penalties of a DUI (Driving under intoxication) conviction. Not all states currently support zero tolerance; those who do maintain limits of anywhere from 0.02 to 0.00 as the threshold for their policies (varies by state). Success of these policies in impacting underage drinking and driving varies with the levels of enforcement and publicity around the regulations (Wilson, 2013). Studies have shown that extensive publicity of zero tolerance laws can dramatically reduce crash and injury rates (Goodwin, 2013).
There are additional laws associated with a minimum legal drinking age, such as restrictions on providing someone with alcohol when they are not of legal age, and requirements for alcohol retailers to restrict service to young people. While these vary by locale, they are consistent with their intent, which is to restrict access to those who do not meet the MLDA.
Cell phone use laws
Data supports teen drivers as higher users of cell phones than adult driver counterparts. As of 2014, legislation in more than 80 percent of US states prohibits cell use among novice teen drivers. While data shows very little impact on usage levels or accidents with implementation of a teen-only law, a community-wide cell phone ban has been shown to significantly impact teen crash rates (Buckley, Chapman & Sheehan, 2014). Additional research has maintained that cell phone bans prohibiting all phone use (excluding hands-free) are of significantly higher impact than those that focus only on banning texting (Fischer, 2014).
Seat belt laws
Every state and territory in the United States has some variety of law governing the use of seat belts in vehicles, however these restrictions vary significantly. Certain laws only apply to the driver,
to passengers, or to minors in the car. In addition, not all laws allow for enforcement officers to cite a violator for non-seat belt use unless they are identified as committing an accompanying traffic offense at the same time—these refer to secondary enforcement versus primary enforcement policies. Teen drivers and passengers consistently demonstrate lower belt usage rates than adults, and as a result some states have an explicit inclusion of belt use as part of their graduated driver’s licensing (GDL) requirements. This is most significant for states that do not have primary
enforcement capabilities with belt usage. Primary enforcement laws have been shown to increase teen compliance with safety restraints (both as drivers and passengers) by up to 15 percent (Goodwin, 2013).
Graduated driver’s license (GDL) restrictions
A Graduated Driver’s Licensing (GDL) program requires that new teen drivers work through a series of stages in order to transition from being a novice driver, to a fully licensed driver without any restrictions. While all states in the U.S. have some type of GDL in place, not all maintain the same levels of restriction. It is worth noting that while teen driving incidents in the U.S. are still disproportionate to the size of the population, there was a significant decline in teen-related traffic injuries and crashes between 1996 and 2010. While the specific reason is unknown, it is suspected by many researchers that the implementation of multi-phase driver licensing programs in a number of localities during this time period had a strong relationship to this impact (Goodwin, 2013).
The Insurance Institute for Highway Safety (IIHS) rated a GDL law as good if it had five or more of the following seven components: (1) minimum age for a learner’s permit; (2) mandatory waiting period before applying for intermediate license; (3) minimum hours of supervised driving; (4) minimum age for intermediate license; (5) nighttime restriction; (6) passenger limitation; and (7) minimum age for full licensing (Fell & Romano, 2013). Research validates that that this phased approach significantly decreases negative teen driving outcomes by addressing both inexperience and immaturity in teen drivers (Goodwin, 2013). Interestingly, data also shows that even when a well-designed GDL is not well enforced, its presence still has a significant impact on teen driving safety. The assumption among parents and teens that the GDL is well enforced is more valuable than actual enforcement efforts (Goodwin, 2013).
With regard to learner’s permit length and minimum age, there were positive correlations with an increased length needed to hold a learner’s permit (6 mos. minimum, with improvements noted for 9-12 month periods), as well as with minimum ages for learners of no less than 14 years of age, with increasingly positive outcomes as the minimum age increased. Supervised driving hours (able
to be proctored by parents or other responsible adult licensed drivers) ranged in state
requirements from none, to 70 hours of requirement, with an average between 30 and 50 needed before transition from a learner’s permit to an intermediate license.
The minimum age for intermediate license achievement in any state is age 14 (in South Dakota), although most states do not offer the ability to achieve this phase until a minimum of age 16 (IIHS, 2015). During this intermediate licensing phase, nighttime driving and passenger restrictions are common. Nighttime restrictions for drivers in an intermediate stage of licensure exist in almost every state, but hours of ‘night’ vary from 6 p.m. to 6 a.m. as the most restrictive definition, and 1 a.m. to 5 a.m. as the least. The most common hours are from between 11 and 12, until either 5 or 6, but data supports that many teen crashes actually happen before 12 a.m.,
supporting an expansion of night hours to begin earlier. Data indicates a direct correlation between increased prevention and a wider definition of night hours (Preusser & Tison, 2007). For GDL most passenger restriction includes restriction by quantity, age or both. Some states allow for exception for family/household members. Strong evidence supports a reduction in injury and crash amongst teens with this restriction in place, as long as there is significant enforcement (Goodwin, 2013).
Minimum age for full licensing in teens has a direct relationship to prevention of teen driver fatalities, with positive relationships in reduction of risk associated with an increased age of full (unrestricted) driver licensure. States’ regulations vary between age 16 (with a minimum waiting period of intermediate licensing) to age 18, with most programs utilizing ages 17 and 18 (IIHS, 2015).
2. Policy Enforcement
Enforcement culture surrounding public policy is a critical issue, considering that when surveyed as to their likelihood to comply with a stated law or regulation, both teens and parents displayed a significantly stronger likelihood to prioritize a law that they felt was highly enforced (Fischer, 2014).
Of particular note is the GDL restriction on number of passengers permitted in an
intermediately licensed teen driver’s vehicle. While many teens admitted to violating the stated passenger limit without their parents’ consent or knowledge, a significant number surveyed
indicated that their parents were aware of their violation and did not object to it, due to a perceived lack of local enforcement. When considering that statistically teen passengers are the number one predictor of a teen driver’s likelihood to be in a distracted-driving-related incident, this finding is significant.
From the perspective of the Social Ecological Model, policy enforcement contributes to the same span of SEM levels as the public policies it supports. As another highly ‘nested’ strategy, enforcement impacts outcomes at every level (community, organizational, interpersonal and intrapersonal) and contributes substantially to the prediction of a policy’s success or failure to significantly reduce risky behaviors and negative outcomes.
Of importance is the substantial relationship between the successes of enforcement initiatives when paired with pre-publicity of their scheduled occurrence (Solomon, Tison, & Cosgrove, 2013). While the enforcement of a public policy will impact an individual who is immediately being penalized (at inter and intrapersonal levels), successful ability to publicize the occurrence of this enforcement allows the impact to permeate at a community level.
Strength of enforcement
Many policies surrounding teen driving are subject to a classification of either ‘primary’ enforcement or ‘secondary’ enforcement enabled. This refers to the fact that an officer is able to issue a citation for an observed violation of a primary enforcement issue without any other cause needed, while in a scenario with secondary enforcement capability only, an officer can only issue a citation if and when the behavior occurs in tandem with some other offense that is supported by primary enforcement. Examples of this exist in seat belt legislation and GDL legislation, wherein a driver may not being wearing their seat belt or may have passenger in their car when not allowed by law, but in a secondary enforcement scenario they could only be ticketed for these violations in the event they were pulled over for speeding (or some other driving offense).
Additional issues around strength of enforcement exist with the application of policies to certain population members, and not to others. An example is the scenario of a state that allows fully licensed drivers (who could be as young as 16) to use their cell phone while driving, but prohibits drivers who are in a graduated phase of licensure (learner or intermediate stage) to use their phone. When surveyed, law enforcement officers in multiple communities have indicated that the difficulty of identifying a clear violation of a limited or secondary enforcement policy has made them less likely to issue citations, even when in observation of a behavior that could be in violation (Fischer, 2014). The state of New Jersey has taken a unique approach assisting officers in easily identifying teen drivers who are subject to the restrictions associated with GDL. The state requires that all teen drivers have a reflective sticker affixed to the license plate of their vehicle. Review of this process showed that while citation levels went up, teens’ self-reported violations did not
decrease, and multiple parents and teens identified avoided compliance with sticker use (Goodwin et al, 2013).
Penalties (and consistent application of them) are also considered a factor in the perceived ‘strength’ of enforcement. In communities where penalties are well known and cases of violation are consistently adjudicated to apply these penalties, teens indicate a higher likelihood to adhere to established regulations. A study regarding the enforced punishment with violation of certain states’ GDL programs (delay of continuation in the licensing process) revealed certain challenges (Shaffer et al., 2008). The research didn’t support that a more strict enforcement of GDL equals lower crash/incident rate. The general conclusion by researchers is that the penalties for violating GDL requirements are not well known, as well as not well enforced, and that the proposed punishment of licensing delays is infrequently applied—even in the case of violation (Shaffer et al., 2008).
Enforcement culture and knowledge base
While officers identify a reluctance to maintain some policies due to difficulty in certain policy enforcement components (i.e. only part of a population is held accountable, etc.), other surveys amongst law enforcement officers have identified that this can also be a challenge of culture within the law enforcement team (Fischer, 2014). An officer’s likelihood to attempt enforcement can increase in the event of focused training and increased knowledge of issues surrounding enforcement of teen driving policies.
There are a number of programs that provide specific training to officers in order to educate them on the potential negative consequences that can come from unsafe teen driving behaviors, as well as the overall impact that their enforcement efforts can have on the health and well-being of their communities (Adkins, 2014).
Resource allocation
HVE- also known as high visibility enforcement activity, or STEP- selective traffic enforcement programs- are two approaches for enforcement that operate on the premise of increasing the presence of patrols in a concentrated period of time, with either a particular population focus, particular geographic focus, or particular behavior target. By providing the resources to support overtime funding to allow this increased presence, states have seen significant results accompany their investment. A well-known example of this approach is the nationwide “Click-it or Ticket” campaign that spends a two-week period in the spring with a national increase in law enforcement patrols scanning for violators of seat belt requirements. The data show that while an increase in the
presence of law enforcement officers will always result in an upswing in the number of citations for a particular infraction, the real goal (decreased crashes and injuries) is best achieved when this proposed increase in enforcement is promoted publicly ahead of the proposed time of increased enforcement (Solomon, Tison, & Cosgrove, 2013).
In a Wisconsin-based enforcement campaign targeting teens attempting to purchase alcohol underage, officers were paid overtime to visit local liquor stores and intercept youth purchasing from the stores against legal restrictions. A noteworthy result from this campaign was the importance of applying increased enforcement efforts to a wide target of establishments, as the finding was that rumor and reputation of increased enforcement efforts were only effective if there was a legitimate perception that the perceived threat of increased enforcement would actually be fulfilled (Goodwin, 2013).
3. Community Roles
Cultural norms around risky teen driving behaviors play a significant role in the disruption or continuation of these actions. As (another) specifically identified level within the Social Ecolog
